| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
124 |
57 |
$10K |
| 99205 |
Prolong outpt/office vis |
12 |
12 |
$2K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
28 |
28 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
12 |
$2K |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
512 |
456 |
$1K |
| 99000 |
|
1,479 |
1,241 |
$1K |
| 96127 |
|
48 |
48 |
$843.71 |
| S3620 |
Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total) |
52 |
39 |
$224.78 |
| 88720 |
|
46 |
27 |
$213.41 |
| 99072 |
|
104 |
87 |
$40.00 |
| 36416 |
|
58 |
39 |
$6.40 |